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Many patients wish to receive end-of-life care at home. Liberal professionals are necessarily called upon to help in these situations. The issues most frequently raised are the management of specific symptoms, lack of knowledge of palliative care support structures, and a feeling of isolation among caregivers.
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Servicios de Atención de Salud a Domicilio , Cuidados Paliativos , Humanos , Cuidados Paliativos/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Francia , Cuidado Terminal , Práctica Privada de EnfermeríaRESUMEN
INTRODUCTION: The "Programme d'Accompagnement du retour à Domicile" (PRADO) COPD is a home discharge support program dedicated to organizing care pathways following hospitalization for COPD exacerbation. This study aimed at assessing its medico-economic impact. METHODS: This was a retrospective database study of patients included in the PRADO BPCO between 2017 and 2019. Data were extracted from the National Health Data System. A control group was built using propensity score matching. Morbi-mortality and costs (national health insurance perspective) were measured during the year following hospitalization. RESULTS: While the proportion of patients with a care pathway complying with recommendations from the National Health Authority was higher in the PRADO group, there was no significant effect on mortality and 12-month rehospitalization. In the PRADO group, the rehospitalization rate was lower when the care pathway was optimal. Healthcare costs per patient were 670 higher in the PRADO group. CONCLUSIONS: The PRADO COPD improves quality of care but without decreasing rehospitalizations and mortality, although rehospitalizations did decrease among PRADO group patients benefiting from an optimal care pathway.
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Costos de la Atención en Salud , Readmisión del Paciente , Enfermedad Pulmonar Obstructiva Crónica , Humanos , Masculino , Femenino , Enfermedad Pulmonar Obstructiva Crónica/terapia , Enfermedad Pulmonar Obstructiva Crónica/economía , Estudios Retrospectivos , Anciano , Persona de Mediana Edad , Costos de la Atención en Salud/estadística & datos numéricos , Costos de la Atención en Salud/normas , Anciano de 80 o más Años , Readmisión del Paciente/estadística & datos numéricos , Readmisión del Paciente/economía , Alta del Paciente/estadística & datos numéricos , Alta del Paciente/normas , Alta del Paciente/economía , Servicios de Atención de Salud a Domicilio/economía , Servicios de Atención de Salud a Domicilio/normas , Servicios de Atención de Salud a Domicilio/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/organización & administración , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Francia/epidemiología , Evaluación de Programas y Proyectos de Salud , Análisis Costo-BeneficioRESUMEN
In 2023, the "Amae" mobile perinatal early intervention team in the child psychiatry department of the Pitié-Salpêtrière hospital followed 49 families for almost 412 home visits. The coexistence of biopsychosocial vulnerability factors was the rule. Generally requested by maternity hospitals (45% in antenatal care), the team offers care focused on parent-child bonds during visits at home, and facilitates the articulation of the different fields involved in contexts at high risk of care breakdown.
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Atención Perinatal , Humanos , Femenino , Embarazo , Unidades Móviles de Salud , Recién Nacido , Grupo de Atención al Paciente , Intervención Médica TempranaRESUMEN
The parent-baby unit at the Jean-Verdier hospital in Seine-Saint-Denis offers outpatient and mobile care. Migrant families in extremely precarious situations, often with traumatic histories, are met. Home visits facilitate access and continuity of care. Nonetheless, this work and the broader context in which it is carried out have an impact on the therapists' experience and care methods. This makes it all the more essential to have a co-therapy system in place, to take primary needs into account and to support mothering care in therapeutic work.
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Servicios de Atención de Salud a Domicilio , Humanos , Femenino , Recién Nacido , Embarazo , Atención Perinatal , FranciaRESUMEN
With the aim of describing the activities of nurses in mobile home palliative care teams in the Brussels Region, the study Nursing practices in palliative care in Brussels outpatient mobile teams took the cultural intermediary model as its theoretical framework. This model is based on in-depth research into the history of the nursing discipline. This article provides an overview of this European conceptual model, its integration into a descriptive study, and highlights some of its contributions.
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Cuidados Paliativos , Humanos , Cuidados Paliativos/organización & administración , Modelos de Enfermería , Enfermería de Cuidados Paliativos al Final de la VidaRESUMEN
The first home visit (VAD) by a nurse from the medical-psychological center (CMP) for a patient who has been out of psychiatric care for a very long time, or who has never benefited from it, is decisive for the follow-up and continuity of care. The attitude and posture of the caregiver are decisive. VAD is an intrusion into a place of life, intimacy and suffering. It upsets a person who has walled himself into a shell, a cocoon, from which the fear of coming out is often massive. Anguish prevents any mobilization towards care. It takes a great deal of skill to create a bond of trust to initiate the idea of care.
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Visita Domiciliaria , Humanos , Trastornos Mentales/terapia , Trastornos Mentales/enfermería , Continuidad de la Atención al Paciente/organización & administraciónRESUMEN
INTRODUCTION: Preterm premature rupture of membranes (PPROM) is the main cause of premature delivery, complicating 1-3% of all pregnancies. Conventional hospitalization (CH) is the most frequent mode of follow-up, but homecare (HC) seems to be an alternative. OBJECTIVES: Study of the impact of the monitoring mode on the duration of the latency period and on the latency ratio after PPROM, and analysis of the risk factors modifying this ratio. METHODS: This was a bicentric retrospective cohort study here-abouts including patients who presented a PPROM between 24 and 36weeks of gestation from 2016 to 2018. Patients had a follow-up in HC at Lille University Hospital center (UHC) and in CH at Nantes UHC according to two different follow-up protocols. The latency ratio corresponded to the real latency period divided by the latency period to theoretical term. RESULTS: We included 154 patients: 102 in HC and 52 in CH. The mean latency period was significantly higher in HC: 36.9±21.8 days, corresponding to an 85.5±23.7% latency ratio versus 20.2±12 days, corresponding to an 66.9±29.8% latency ratio in CH (P<0.001). The latency ratio in CH was correlated with term at PPROM (P=0.001). CONCLUSIONS: The duration of the latency period seems prolonged for PPROM followed by HC management versus CH in selected populations. This study suggests a benefit to HC in stable patients.
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BACKGROUND: In this article, we apply a gender-based analysis plus framework to research the housing experiences of older, low-income adults living and aging in Hamilton. Low-income older adults with intersectional identities are at risk of not aging in place due to marginalization and housing instability. OBJECTIVE: Policy currently homogenizes the experience of aging by sidelining intersectional factors that have a bearing on aging well in place. The research aims to develop policy recommendations to address this gap. METHODS: Several methods captured the housing experiences of low-income older adults, including interviews, participant observation, and arts-based techniques. FINDINGS: Findings illustrate how gender and intersectional factors shape both housing trajectories and agentive practices low-income adults utilize to try to age well and in place. These strategies encompass practicing cultural citizenship, which is a claim for inclusion when excluded from mainstream ideals of aging in place. DISCUSSION: We provide policy recommendations informed by participants' lived experiences aimed at promoting equitable aging in place as fundamental to full citizenship.
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Patients hospitalised with acute venous thromboembolism (VTE), and notably patients with pulmonary embolism, often remain in hospital for extended periods due to the perceived risk of complications. However, several studies have shown that home treatment of selected patients is feasible and safe, with a low incidence of adverse events. This may offer clear benefits for patients' quality of life, hospital planning and cost to the health service. Nonetheless, there is a need for a VTE risk-stratification tool specifically addressing prognosis in patients with cancer. This may aid in the selection of low-risk patients with cancer and VTE who are suitable for outpatient treatment. Although several prognostic scores have been proposed, we suggest using a pragmatic clinical decision-making tool such as the Hestia criteria for selecting patients for home care in everyday clinical practice. Once patients have been discharged, it is mandatory to monitor patients regularly (we suggest after 3 days, 10 days, 1 month and 3 months, or more frequently if needed) with the involvement of a multidisciplinary team, so that appropriate and timely remedial action can be taken in case of warning signs of complications. If patients are selected carefully and monitored effectively, many patients who experience acute VTE can be cared for safely at home.
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Servicios de Atención de Salud a Domicilio , Neoplasias , Tromboembolia Venosa , Humanos , Tromboembolia Venosa/epidemiología , Tromboembolia Venosa/etiología , Tromboembolia Venosa/terapia , Tromboembolia Venosa/diagnóstico , Neoplasias/complicaciones , Neoplasias/terapia , Neoplasias/epidemiología , Servicios de Atención de Salud a Domicilio/normas , Servicios de Atención de Salud a Domicilio/organización & administración , Francia/epidemiología , Calidad de Vida , PronósticoRESUMEN
Many elderly people live well and at home, but some require somatic and psychiatric care. Mobile psychiatric teams for the elderly are called upon to intervene with people aged 65-70 and over who are experiencing psychological distress. Among senior citizens, addictive disorders are very common, and are associated with psychiatric and geriatric co-morbidities. Alcohol, tobacco and benzodiazepine use disorders require holistic, individualized care, based on identification, prevention and referral, as well as training and coordination of professionals and caregivers.
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Comorbilidad , Anciano , HumanosRESUMEN
Setting up a device-based treatment for a Parkinson's patient at home is a complex affair. The homecare nurse, an expert in this pathology, coordinates the various professionals working with the patient, and is the privileged contact for the prescribing doctor. Thanks to his or her wide range of skills, he or she can provide invaluable assistance to ensure that the patient's care goes smoothly.
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Enfermedad de Parkinson , Médicos , Humanos , Masculino , Femenino , Enfermedad de Parkinson/terapiaRESUMEN
Multidimensional, chronic, progressive and incurable, Parkinson's disease is, by definition, a palliative disease, and this from the moment of diagnosis. This vision, relatively new to neurology, calls for a paradigm shift, as well as a dual medical-paramedical and home-hospital alliance. This approach allows us to better understand the specificities of Parkinson's disease and its treatments in terms of palliative issues.
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Enfermedad de Parkinson , Cuidado Terminal , Humanos , Cuidados Paliativos , Enfermedad de Parkinson/terapiaRESUMEN
INTRODUCTION: Quality of life (QoL) and patient satisfaction are major concerns in oncology. METHODS: The aim of this prospective observational study was to evaluate these parameters according to the mode of administration of anti-HER2 (subcutaneous [SC] versus intravenous [IV]), the place of administration (Home Hospitalization or HOD versus hospital) for patients supervised by an advanced practice nurse (APN). RESULTS: Between January 2022 and June 2023, 32 patients were included. They were statistically more satisfied with subcutaneous management (P=0.0004), a result explained by the speed of administration (43.5%), comfort during administration (26%) even though some expressed pain on injection and felt less anxiety (26%). Management by the APN seems more appropriate when anti-HER2 drugs were administered in HOD. In HOD, patients perceived an overall improvement in their quality of life, appetite and cognitive abilities, with a reduction in fatigue, pain and depression (P<0.05). However, the rate of outsourcing to HOD remained too low (30.4%), as 56.3% of patients would have liked to be cared for in HOD if they had had the opportunity. CONCLUSION: SC administration of anti-HER2 under the supervision of an APN has advantages for the patient, resulting in greatest satisfaction and improved patient QOL, preferably in HOD.
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Neoplasias de la Mama , Satisfacción del Paciente , Calidad de Vida , Receptor ErbB-2 , Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/psicología , Estudios Prospectivos , Persona de Mediana Edad , Receptor ErbB-2/antagonistas & inhibidores , Inyecciones Subcutáneas , Anciano , Ansiedad , Hospitalización , Adulto , Trastuzumab/uso terapéutico , Trastuzumab/administración & dosificación , Depresión , Fatiga , Antineoplásicos Inmunológicos/uso terapéutico , Antineoplásicos Inmunológicos/administración & dosificación , Apetito/efectos de los fármacosRESUMEN
The purpose of this study was to examine the perspectives of support staff, health care professionals, and care coordinators working in or referring to a community-based, slow-stream rehabilitation, hospital-to-home transition program regarding gaps in services, and barriers and facilitators related to implementation and functioning of the program. This was a qualitative descriptive study. Recruitment was conducted through purposive sampling, and 23 individuals participated in a focus groups or individual semi-structured interview. Transcripts were analyzed by six researchers using inductive thematic analysis. Themes that emerged were organized based on a socio-ecological framework. Themes were categorized as: (1) macro level, meaning gaps while waiting for program, limited program capacity, and gaps in service post-program completion; (2) meso level, meaning lack of knowledge and awareness of the program, lack of specific referral process and procedures, lack of specific eligibility criteria, and need for enhanced communication among care settings; or (3) micro level, meaning services provided, program participant benefits, person-centred communication, program structure constraints, need for use of outcome measures, and follow-up or lack of follow-up. Implementation of seamless patient information sharing, documentation, use of specific referral criteria, and use of standardized outcome measures may reduce the number of unsuitable referrals and provide useful information for referral and program staff.
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Ríos , Cuidado de Transición , Humanos , Anciano , Investigación Cualitativa , Grupo de Atención al Paciente , HospitalesRESUMEN
The success of home hemodialysis depends on several criteria. On the one hand, the patient's willingness to be autonomous, his or her degree of understanding, the technical feasibility at home, and the presence of a third party. Secondly, the quality of initial training (which must respect the patient's rhythm) and follow-up at home. This is a true patient-caregiver partnership, based on trust. Home visits are part of this approach, and help maintain the link, as a team at Caen University Hospital can testify.
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Hemodiálisis en el Domicilio , Visita Domiciliaria , Humanos , Masculino , Femenino , CuidadoresRESUMEN
Hereditary epidermolysis bullosa is also known as the "butterfly child" disease. By no means bucolic, the expression of this cruel pathology makes the lives of affected patients a daily struggle against sores covering the body, causing pain and requiring conscientious care. Like the disease itself, the care provided by a nurse at home is heavy, complex... and rare. Preventive care, education, assessment and dressing repairs are all part of nursing care, but are mainly carried out by relatives, or even by the patient him/herself. A further burden for these people, who are heavily impacted physically, psychologically and socially.
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Epidermólisis Ampollosa , Servicios de Atención de Salud a Domicilio , Enfermeros de Salud Comunitaria , Atención de Enfermería , Humanos , Masculino , Escolaridad , Epidermólisis Ampollosa/enfermería , FemeninoRESUMEN
The objectives of this feasibility study were to measure the prevalence of nutrition risk in community-dwelling older adults (CDOA, ages ≥ 65 years) and explore the perspectives of CDOA of the acceptability, value, and effectiveness of nutrition risk screening in primary care and community settings. Using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)© eight-item tool (n = 276), results indicated that moderate and high nutrition risks affected 50 per cent and 8 per cent, respectively, of those screened. Interviewees (n = 16) agreed that screening is acceptable, important, and valuable (Theme One). Effectiveness was unclear, as only 3 of 16 respondents recalled being told their nutrition risk status. When articulating nutrition-related issues, a food security theme, expressed in the third person, was prominent (Theme Two). Screening for nutrition risk and receiving nutrition information in community-based settings are acceptable to CDOA and medically necessary, as evidenced by the high proportion of CDOA at moderate-high nutrition risk.
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Non-drug interventions (NDIs) are recommended as a first-line treatment in gerontology to address the psychological and behavioral symptoms of dementia. This article illustrates the NMIs implemented, how they are carried out and how they are evaluated as part of the Bien vieillir project at Nice University Hospital.
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Demencia , Geriatría , Trastornos del Humor , Humanos , Envejecimiento , Trastornos del Humor/terapiaRESUMEN
This feasibility study of routine nutrition risk screening in community-dwelling older adults using a partnership between health care and community-based organizations (CBO) aimed to (1) evaluate the ability of community-based partnerships to provide screening for nutrition risk, and appropriately refer at-risk individuals for follow-up care and (2) determine the barriers to and facilitators of screening. Adults 65 years of age and older were screened by staff in two primary care and one CBO setting using the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN)-8 nutrition risk screening tool. Screeners, organization administrators, and registered dietitians responded to surveys regarding SCREEN-8 administration, referral processes, and partnership interactions. All found the SCREEN-8 initiative feasible, acceptable, and appropriate. Sustainability requires strengthening of community resources, referral processes, and telephone assessments. The partnership added value despite limitations in communications. We conclude that broader implementation of this program using community-based partnerships has the potential to aid in the prevention of malnutrition in older adults.
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The six pediatric care units of the Assistance publique - Hôpitaux de Paris home hospitalization service provide daily care for 150 children. A small proportion are treated for enzyme-deficiency diseases at the reference centers of the Necker-Enfants malades and Armand-Trousseau hospitals. Treatment consists of a weekly injection of enzyme therapy, lasting from three to five hours. In order to reduce the time spent by the nursery nurse, while guaranteeing the quality and safety of care, a team discussion led to the drafting of a procedure for harmonizing practices and empowering families to carry out this enzymotherapy injection.